WEDNESDAY, Sept. 7 (HealthDay News) -- John Feal need only look down each morning to remember the devastation of Sept. 11, 2001.

Feal was a construction supervisor who went to help at Ground Zero the day after the terrorist attacks. As he worked among the rubble, 8,000 pounds of steel shifted and Feal lost half his left foot when it was crushed by the weight.

More than a year of physical and mental therapy followed, after which Feal founded an advocacy group for first responders. He also received a New York State Congressional Medal of Honor for Civilians Above and Beyond for his advocacy work and for donating a kidney to a complete stranger.

As the 10th anniversary approaches and the world gets ready to relive the day, Feal appears to be facing the memory calmly.

"I don't know if it's a gift or a curse, but I can block 9/11 out," he said. "Every day I wake up looking at half a foot, but it's a reminder of what I've been through . . . I can embrace it because I accept history. I don't stay in the past at all."

Mental health experts say that almost any reaction to the milestone -- whether flashbacks, anger, overwhelming grief or a sense of resolution -- can be considered normal.

But they also expect that the well-known phenomenon known as "anniversary reaction" -- which tends to reawaken feelings associated with deep bereavement -- will be in full force over the next several days, even among typical Americans whose losses that day were confined to a broader sense of safety and peace.

TV news images of the Twin Towers falling -- already on the air for weeks as networks run retrospectives on the catastrophe -- can easily summon the acute trauma of the event, as can innocuous details like a cloudless, crystal-blue sky or the sound of a jet roaring overhead.

"It's often the result of feeling, once again, the fear or sadness or outrage," said Jeffrey Jay, a psychologist in private practice in Washington, D.C., who has counseled 9/11 survivors from the Pentagon. "Sometimes anniversary reactions come on quickly, but also dissipate relatively quickly. But the intensity surprises people and worries them," he explained.

"It may take the person down very deeply to feeling just what it was like," Jay added, "but it tends not to last very long."

Deep-seated wounds

That's not to say, however, that more subtle mental health effects of the terrorist attacks haven't long taken hold in many of those most closely affected. Just this past month, Jay helped a longtime Pentagon employee realize that a host of insidious symptoms for which she had repeatedly sought medical attention were actually due to her psychological trauma a decade ago.

"She thought it was menopause, a virus -- she had many physical symptoms," Jay said, noting that the woman has now retired from the Pentagon. "She was extraordinarily grateful and in tears to understand that this goes back to 9/11. People continue to suffer and it's not always clear what's going on."

Ten years later, however, it's clear that emotional trauma runs rampant in many of those who witnessed the horrors of the day firsthand. A January 2010 study by Columbia University's Mailman School of Public Health found that nearly 96 percent of World Trade Center evacuees reported at least one current post-traumatic stress symptom and 15 percent screened positive for the full-blown illness, PTSD, within two to three years of the disaster.

PTSD is a psychiatric disorder that occurs after experiencing or witnessing events that threaten death or serious injury and involving intense feelings of fear, helplessness or horror. It is the third most common anxiety disorder in the United States.

"Cancer is the quintessential disease from 9/11," said Feal, whose non-profit organization, the FealGood Foundation, spreads awareness about the many ongoing health effects of the attacks and subsequent cleanup. "But PTSD, in my mind, will be the number one killer of 9/11 responders. The stress, compounded by the financial devastation, compromises the immune system and that expedites your death."

The flip side, of course, is the remarkable resilience displayed by some -- like Feal -- who turned the awful situation into opportunities to heal and help others.

Jay Winuk co-founded MyGoodDeed.org, a non-profit organization helping establish Sept. 11 as a recognized day of service, in honor of his younger brother Glenn, who died when the South Tower collapsed. Glenn Winuk, 40, was an attorney and volunteer firefighter who lost his life trying to evacuate others.

Winuk, who lives in Putnam County, N.Y., feels the 10-year anniversary is gratifying because it's re-focusing attention on the nearly 3,000 people who were lost on that day, each with his or her own inspiring story.

"At the same time, it's very bittersweet," said Winuk, a public relations professional. "I think of my brother every day and miss him every day. It's not as though the 10-year anniversary brings me back to something I pushed aside. [But] my brother was murdered in a mass murder by terrorists, and that changes your life."

From hurt comes healing

Billie A. Pivnick, consulting psychologist to Thinc Design
partnered with the National September 11 Memorial and Museum, said responses such as Winuk's and Feal's might offer an extra layer of protection against pervasive psychological damage stemming from such a trauma.

"What getting involved in these organizations does is help turn passive helplessness into active mastery," said Pivnick, who also runs a private practice in New York City. "To the degree that they've been able to reverse this sense of helplessness, they're not stuck in trauma."

Feeling "stuck" in post-Sept. 11 emotions -- having nightmares, endlessly replaying the day's events mentally, or scrupulously avoiding all reminders -- is probably not the norm for survivors, family members or first responders, said Karla Vermeulen, deputy director of the Institute for Disaster Mental Health at the State University of New York at New Paltz.

But for those who are, Vermeulen's advice would be to seek counseling and avoid overexposure to media images of the attacks or their aftermath.

"It can have a cumulative effect no one's really aware of," she said. "Be aware of that and limit exposure, and especially with kids."

Winuk plans to visit Ground Zero on Sept. 11, as he has every year since 2001, along with helping to stage service events in 24 cities in partnership with the HandsOn Network. His approach to the anniversary, both personal and public, is the right mix for his own health, he feels.

"I feel good about working on this because it's a forward-looking observance," Winuk said. "I feel that if even one person is helped as a result of Glenn's actions, that makes me feel good, as someone who has lost someone in this way."